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FNP Review 9

GI signs symptoms constipation

symptom or diagnosis where there is decrease in the frequency of stools, excessive difficulty passing stools & straining with defecation constipation
constipation: etiology (general) functional: most common cause psychogenic, neurologic, metabolic disorders, obstruction, medications
constipation: assessment: history determine pt/family definition of constipation; stool history; current pattern, character,etc; use of laxatives, manual extraction, incontinence; medication, fluid intake, abd/rectal pain, family hx (Hirschsprug's disease), toileting history
constipation: assessment: physical exam VS, growth, weight, distention, tenderness, palpable stool in colon, bowel sounds, rectal exam-sphincter toner, fissures, mass,etc;
what do you assess in elderly patient with c/o constipation signs of fever, delirium, urinary retention, arrhythmias, tachypnea
constipation: diagnostic studies stool for occult blood; CBC ;electrolytes, calcium, BUN, creatinine, glucose; thyroid fxn; flat plate & upright abd film; colonscopy or barium enema r/o anemia, leukocytosis, colorectal cancer, hyperparathyrodism, hypokalemia, hypercalcemia, uremia; hypothyroidism; obstruction; constipation onset age >40 with
constipation: differential diagnosis: adult colon cancer, hemorrhoids, irritable bowel syndrome, obstruction
constipation: differential diagnosis: children Hirschsprung, cerebral palsy, cystic fibrosis, breastfeeding, Down syndrome, obstruction
constipation: management: nonpharmacologic treatment for infants <6 months: continue with formula or breast milk; review formula preparation & fluid intake of breastfeeding mom; 6-12months: continue breastfeeding/present formula; add water between feeding; high fiber food prunes, apricot
constipation: management: nonpharmacologic treatment for toddlers & preschoolers increase water intake; decrease juice intake; whole fruits instead of juice; daily fiber intake=child's age +5
nonpharmacologic treatment for all over 5 yr increase daily fiber intake (age 3-15)=age+5 ; adults=20-35 g/day; increase fluid intake (water) adults =2L/day; physical exercise; bowel training/behavior modification
treatment: nonretentive encopresis increase child's responsibility; stop pressure on child regarding defecation
constipation:when start pharmacologic tx after month of nonpharmacological tx
constipation: pharmacologic tx: children lactulose, sorbital, Miralax; mineral oil orally > 1yr; home colonic clean out with high dose miralax or repeated dose magneium citrate; surfactants to soften stool (docusate sodium)
constipation: pharmacologic tx: adults hydrophilic colloids/bulk forming agents: psyllium, methylcellulose, polycarbophil; surfactants to soften stool-docusate sodium for short term use; osmotic laxatives such as magnesium hydroxide suspension, magnesium citrate, sodium phosphate enema
Lubiprostone (Amitiza) treat chronic constipation in adults
management for constipation with fecal impaction remove impaction with sodium phosphate enema over 2 days; begin long term therapy with mineral oil, lactulose; treat for 3-6 months along with nonpharm tx; follow up every 2 month after impaction for 6months
constipation: when to consult, refer, hospitalize GI referral-tx failure, stool positive for occult blood, symptomatic >50 yr old; children-failed disimpaction; surgeon-obstruction
functional causes of constipation poor dietary intake of fiber & fluids, behavioral habits such as change in environment with travel or schedule, sedentary lifestyle
encorpresis fecal soiling or staining underwear after 4 years of age either due to retentive constipation or other factors (ie. resistance to toilet training)
Created by: deleted user